Asian Indians and Pakistanis (South Asians) have a disproportionate risk of coronary heart disease (CHD) and are at greater risk for death from CHD compared to all other racial/ethnic groups. There are almost 3 million South Asians Americans; over the past decade they have been the second fastest growing U.S. ethnic group after Hispanics. Relative to Whites, Blacks, Latinos, Japanese, and Chinese in California, South Asians have the highest CHD mortality rates. Behavioral factors contribute significantly to the increased CHD risk observed in South Asians; among all U.S. Asians, South Asians have the highest rates of overweight/obesity and report the least physical activity. Published data strongly support the benefits of healthy lifestyle interventions as a means to decrease CHD risk factors. Facilitating and promoting lifestyle interventions for this growing population could lead to a substantial impact on South Asians' CHD risk; yet knowledge is limited on how best to deliver lifestyle interventions in medically underserved communities and to South Asians, specifically. While clinic-based screening, lifestyle advice, and medication are key to reducing CHD risk factors in individual patients, traditional health care system approaches are unlikely to reach underserved South Asians. Our prior research, conducted in a South Asian community with low socioeconomic status and limited English proficiency, identified several social, cultural, and environmental factors that could limit the impact of clinic- based interventions in this group. Given the limits of clinic-based CHD prevention to address these factors, a culturally-salient lifestyle intervention delivered in the patient's community can enhance the impact of clinical care by: [1] Extending the practical applications of behavioral interventions into underserved neighborhoods; and [2] Filling gaps in clinic-based CHD risk factor management, such as lack of time to engage in lifestyle counseling, limited knowledge about different cultural groups, limited awareness of neighborhood resources, and lack of between-visit support. In partnership with the community, the research team used formative data and health behavior and learning theory to develop the South Asian Heart Lifestyle Intervention (SAHELI), a culturally targeted, group-based, CHD prevention lifestyle intervention for medically underserved South Asians. The intervention incorporates the deep structures of South Asian culture (e.g., explanatory models of CHD) as the mechanism to engage South Asians in CHD prevention and a healthy lifestyle. The goal of this study is to pilot-test SAHELI, via a randomized design, and examine its feasibility and initially efficacy to change physical activity and diet behaviors among medically underserved South Asians in a community-based setting. We will also conduct a process evaluation to understand participants' perceptions of the intervention. This study will provide essential data for the planning of a future large-scale comparative effectiveness trial of differen approaches to enhance CHD prevention in hard to reach South Asian American populations. PUBLIC HEALTH RELEVANCE: Asian Indians and Pakistanis (South Asians) are the second fastest growing minority group in the U.S. and suffer higher rates of coronary heart disease (CHD) compared to other U.S. racial/ethnic groups. Lifestyle interventions could lower South Asians' CHD risk. This study will be one of the first to pilot-test a culturally- salient, communit-based, lifestyle intervention for medically underserved South Asian Americans. Results of this study will advance the development and translation of lifestyle interventions to improve the cardiovascular health of an increasingly diverse American population.